INTRODUCTION
In the last years, the subcutaneous implantable cardioverter
defibrillator (S-ICD) has become an established option to prevent sudden
cardiac death in patients showing high-risk of infection due to
diabetes, chronic kidney disease (CKD), previous cardiac implantable
electronic device (CIED) infections, mechanical heart valves, heart
failure, immunological disorders, use of anticoagulants or
immunosuppressant drugs1,2. Mostly in the same
clinical scenario, absorbable antibacterial envelopes (AAE), as per
International Guidelines3, are recommended, although
data on their use with S-ICDs are currently lacking and they have only
been validated with transvenous (TV) ICDs. Although S-ICD related
infectious complications resulting into device replacement or lead
extraction can be managed easily when compared to TV-ICDs, S-ICDs have
failed to show overall lower rates of infection and are indeed
associated with a higher risk of pocket
complications4. In the present manuscript we aimed to
assess the feasibility of a combined deployment of AAEs and S-ICD in
selected patients at very high-risk of infections and the infectious
outcomes of this specific strategy.